3 Helpful Z Code Hints Every Eye Care Coder Should Know

Tue, Sep 27, 2016


Z codes

Poor ICD-10 Z codes. All the way at the end of the code list and often overlooked. They don’t even get the attention W codes do for interesting adventures involving turtles.

But Z codes do have an important role to play, and today we’re going to show them some love. Let’s look at what these codes have to offer for optometry and ophthalmology services.

1. Know When to Use Routine and Admin Exam Codes

Z codes are in Chapter 21, Factors Influencing Health Status and Contact With Health Services. As the chapter name implies, the codes indicate the reason for an encounter. For eye care, be sure you get to know these codes for routine and administrative examinations:

  • Z01.00, Encounter for examination of eyes and vision without abnormal findings
  • Z01.01, Encounter for examination of eyes and vision with abnormal findings
  • Z02.4, Encounter for examination for driving license.

OG tips: The ICD-10 Official Guidelines (OGs) explain that you should not use these codes if the exam “is for diagnosis of a suspected condition or for treatment purposes.” Use the appropriate diagnosis code in those cases.

The OGs list Z00 and Z01 as categories you may report only as the principal/first-listed diagnosis unless the patient has more than one encounter on that date with combined medical records.

If the provider discovers a condition during the exam, you should report that as an additional code (such as in addition to Z01.01). Choose your codes based on what you know at the time you’re coding. For instance, you can report Z01.00 for no abnormal findings even if test results aren’t in yet.

2. Support Treatment Decisions With Z Codes

Smart coders know when to use Z codes to help tell the story of the patient encounter.

Example: An ophthalmologist spends extra time examining a patient with a history of gestational diabetes during multiple pregnancies. You use Z86.32 (Personal history of gestational diabetes) as an additional diagnosis code to explain the higher level service provided to check for any indications of retinopathy.

Z codes don’t guarantee coverage by any means, but the reality is accurate, compliant coding doesn’t always guarantee coverage.

Just remember to select Z codes based on what’s relevant to the current encounter and what affects patient management.

3. Don’t Double Up on Transplant Codes

You’ll find status codes starting with Z, too, like, Z94.7 (Corneal transplant status). But if you’re reporting another ICD-10 code that refers to the transplant status, you should not report the Z status code, according to both the OGs and an Excludes1 note with category Z94.-.

Example: If you’re reporting a code from subcategory T86.84- (Complications of corneal transplant), you should not also report Z94.7. The T86.84- codes make it clear that the patient has a corneal transplant, so using Z94.7 adds no information to the claim.

How About You?

When do you use Z codes? Have you encountered any problems using these codes? How do you remember to use these codes correctly?

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Discs, GISTs, and Cysts: Look for Location in ICD-10 2017

Fri, Sep 23, 2016


ICD10 2017 site specificity

Are you seeing a theme in blog posts lately? ICD-10 2017! We’ve got just one more week until the new code set goes into effect, so cram time is here. Today we’ll set our sights on three areas that radiology coders may be using soon. The common thread for these code changes is that your 2017 options require you to have a better idea of the specific site involved than the 2016 counterparts required.

Match Mid-Cervical Disc Disorder Code to Level

Watch out for new site requirements for mid-cervical disc disorder codes. (I mentioned this for orthopedic coders, too, but it’s worth repeating.)

Under ICD-10 2017, you’ll need to add a sixth character to identify the level for these subcategories:

  • M50.02-, Cervical disc disorder with myelopathy, mid-cervical region
  • M50.12-, Cervical disc disorder with radiculopathy, mid-cervical region
  • M50.22-, Other cervical disc displacement, mid-cervical region
  • M50.32-, Other cervical disc degeneration, mid-cervical region
  • M50.82-, Other cervical disc disorders, mid-cervical region
  • M50.92-, Cervical disc disorder, unspecified, mid-cervical region.

Your sixth character options for the 2017 codes are below:

  • 0, unspecified level
  • 1, at C4-C5 level
  • 2, at C5-C6 level
  • 3, at C6-C7 level.

Where in the GI Is the GIST?

ICD-10 2016 kept it simple but vague for coding a malignant gastrointestinal stromal tumor (GIST). The Index pointed you to C49.4 (Malignant neoplasm of connective and soft tissue of abdomen).

In 2017, you’ll be using all new, four-character codes specific to GISTs. The codes require you to identify the location of the GIST:

  • C49.A0, Gastrointestinal stromal tumor, unspecified site
  • C49.A1, Gastrointestinal stromal tumor of esophagus
  • C49.A2, Gastrointestinal stromal tumor of stomach
  • C49.A3, Gastrointestinal stromal tumor of small intestine
  • C49.A4, Gastrointestinal stromal tumor of large intestine
  • C49.A5, Gastrointestinal stromal tumor of rectum
  • C49.A9, Gastrointestinal stromal tumor of other sites.

ID Which Ovary and Fallopian Tube for Category N83

In 2017, code options related to cysts, atrophy, prolapse and hernia, and torsion of the ovaries and fallopian tubes will expand to identify the side.

Caution: To create complete codes in category N83, you sometimes need five characters and sometimes need six. And whether you use a 0 or 9 to represent “unspecified side” depends upon the number of characters. If that’s hard to picture, just take a look at the codes below.

Complete at 5 Characters

  • N83.0-, Follicular cyst of ovary
  • N83.1-, Corpus luteum cyst
  • N83.4-, Prolapse and hernia of ovary and fallopian tube

Use these fifth character options:

  • 0, unspecified side
  • 1, right
  • 2, left

Complete at 6 Characters

  • N83.20-, Unspecified ovarian cysts
  • N83.29-, Other ovarian cysts
  • N83.31-, Acquired atrophy of ovary
  • N83.32-, Acquired atrophy of fallopian tube
  • N83.33-, Acquired atrophy of ovary and fallopian tube
  • N83.51-, Torsion of ovary and ovarian pedicle
  • N83.52-, Torsion of fallopian tube

Use these sixth character options:

  • 1, right
  • 2, left
  • 9, unspecified side

What Do You Think?

Radiology coders have a tough task because they code for conditions that affect the entire body, and the nature of ordering and imaging can lead to limited documentation to work with. Do you predict any issues with these new codes?

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Will Urinary Stent Complication Coding Be Clearer in ICD-10 2017?

Tue, Sep 20, 2016


Kidneys ureters bladder ICD10 2017

ICD-10-CM 2017 is bringing changes proposed as far back as 2011 and requested again in 2014 to better represent complications of urinary catheters and other devices. They’ve taken a long time to make their way to you, so be sure you’re using the new codes for dates of service Oct. 1, 2016, and later.

Take a Look at 2016 Urinary Stent Breakdown Codes

Under ICD-10 2016, you choose one of these codes for urinary stent breakdown:

  • T83.112A, Breakdown (mechanical) of urinary stent, initial encounter
  • T83.112D, Breakdown (mechanical) of urinary stent, subsequent encounter
  • T83.112S, Breakdown (mechanical) of urinary stent, sequela.

Focus on 2017 Facelift for T83.112-

T83.112- gets a new look and a spin-off subcategory under ICD-10 2017.

First let’s look at the 2017 descriptors for T83.112-. Be sure to note that the codes continue to require seven characters.

What’s new? The ICD-10 2017 descriptors refer to “indwelling ureteral stent” instead of “urinary stent”:

  • T83.112A, Breakdown (mechanical) of indwelling ureteral stent, initial encounter
  • T83.112D, Breakdown (mechanical) of indwelling ureteral stent, subsequent encounter
  • T83.112S, Breakdown (mechanical) of indwelling ureteral stent, sequela.

Use Spin-Off Codes for Other Urinary Stents

With the 2017 version of T83.112- being specific to indwelling ureteral stents, how will you code for the breakdown of other urinary stents? You’ll use these new-for-2017 codes:

  • T83.113A, Breakdown (mechanical) of other urinary stents, initial encounter
  • T83.113D, Breakdown (mechanical) of other urinary stents, subsequent encounter
  • T83.113S, Breakdown (mechanical) of other urinary stents, sequela.

ICD-10 2017 includes these notes as examples of what’s included in T83.113-:

  • Breakdown (mechanical) of ileal conduit stent
  • Breakdown (mechanical) of nephroureteral stent.

Brush Up on Your Urinary System Terminology

Ureters: The T83.112- 2017 codes are specific to ureteral stents. Ureters are tubes that take urine from the kidneys to the bladder.

Indwelling stent: An indwelling stent is one that stays in the patient’s body for a time after an operation to allow drainage. Examples of these stents include double pigtail or double J type stents, urology experts say.

Watch for Similar Changes to Displacement and ‘Other’

You’ll see some familiar-looking revisions and additions for stent displacement and other mechanical complications, as shown below.



T83.122-, Displacement of urinary stent


T83.122-, Displacement of indwelling ureteral stent

T83.123-, Displacement of other urinary stents

Other mechanical complication:


T83.192-, Other mechanical complication of urinary stent


T83.192-, Other mechanical complication of indwelling ureteral stent

T83.193-, Other mechanical complication of other urinary stent

What Do You Think?

Do you foresee any issues with applying these new codes? Are you glad to see these changes happening?

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Be the First to Conquer ICD-10 2017 Official Guideline Changes

Fri, Sep 16, 2016


prepare for ICD10 2017 Official Guidelines

In the previous post about ICD-10 2017, I mentioned the importance of reviewing the updated Official Guidelines. News of the 2017 OGs being out is enough to make any coder’s pulse quicken, and to keep the excitement going, here’s a quick guide to what’s new in the conventions and general coding guidelines.

Remove the ‘Interim’ From Excludes1 Advice

The 2015 interim advice on using Excludes1 has made its way into the 2017 Official Guidelines, which go into effect Oct. 1, 2016. Section I.A.12.a states that an “exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other.”  The Guidelines go on to say that if the relationship isn’t clear, ask the provider for clarification.

Report Underlying Condition First ‘If Applicable’

When a condition has both an underlying etiology and manifestations, ICD-10 requires sequencing the underlying condition first. The 2017 Guidelines add the important words “if applicable” to this rule in Section I.A.13.

This clarification matches information in AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS, First Quarter 2016: “The ‘code first’ note means code first, if present.”

Consider ‘With’ to Mean ‘Due To’

A change to the convention described in Section I.A.15 has important consequences for those who code hypertensive heart disease.

The revised explanation of “with” says you should presume a causal relationship between two conditions linked by the term “with” in the Alphabetic Index or Tabular List. That means you should code those two documented conditions as related even if the documentation doesn’t specifically link them. But if the documentation states the conditions are unrelated, then you should code them as unrelated.

This change ties into revisions to Section I.C.9.a, Hypertension. In 2016, as cardiology coders likely know, the OGs said you should not presume a relationship when documentation shows hypertension with heart conditions. In 2017, Section I.C.9.a takes a U-turn and says to report hypertension with heart conditions as hypertensive heart disease unless the provider has specifically documented a different cause.

Code Based on Provider’s Statement

Section I.A.19 is a new addition to the OGs and applies to “Code assignment and clinical criteria.”

The rule is that “The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists.  The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis.”

Memorize This Bilateral Coding Rule

If you ever report bilateral conditions, be sure to commit to memory an addition to Section I.B.13, Laterality.

According to the 2017 Guidelines:

  • When a patient has a bilateral condition, assign the bilateral code even when the provider treats each side during different encounters.
  • If at a later encounter, the condition no longer exists on the treated side, but it continues to exist on the other side, report the unilateral code.

Think of the example of a patient with cataracts in both eyes who has surgery on one eye at a time. Before the surgery on the first eye, you’d use the bilateral cataract code. After the surgery on only the first eye, you’d report a unilateral code for the side that still has the cataract.

Add Documentation Flexibility to Coma Scale and NIHSS

You may be familiar with Section I.B.14’s rule that acknowledges real-world documentation practices. In 2016, Guidelines say you may choose a code based on documentation from a clinician who isn’t the provider legally responsible for diagnosing the patient for these:

  • Body mass index (BMI)
  • Non-pressure chronic ulcers depth
  • Pressure ulcer stage.

For instance, dietitians often document the BMI and nurses often document pressure ulcer stage.

In 2017, the Guidelines add two more areas:

  • Coma scale
  • NIH stroke scale (NIHSS).

For example, if an EMT documents the coma scale, you can code based on that documentation.

Watch out: The provider needs to be the one to document the associated diagnosis, such as the acute stroke related to the NIHSS code.

Check It Out for Yourself

We’ve taken just a quick tour of the changes to Section I.A, Conventions for the ICD-10-CM, and Section I.B, General Coding Guidelines. Be sure to review the official language for yourself and read the guidelines for the ICD-10 chapters you use. You’ll discover changes regarding Zika, diabetes, ulcers, obstetrical care, and more.

Remember: If your print ICD-10 2017 manual includes the guidelines, they may be the 2016 guidelines (because the book’s publishing deadline may have been before the 2017 guidelines came out). As we’ve seen, guidelines can change substantially from year to year, so be sure you’re using the guidelines that apply to your date of service.

What About You?

Are you happy or upset about any of these changes? How do you remember to check and apply these guidelines when you code?

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You’ve Got This! Face the End of CMS’s ICD-10 Flexibility Without Fear

Tue, Sep 13, 2016


fear of the end of ICD-10 CMS flexibility

We’re just about two and half weeks away from ICD-10 2017 going into effect on Oct. 1, 2016. As you surely know by now, that date is also the first day without the CMS “ICD-10 flexibilities” that prevent Medicare review contractors (including MACs) from denying Part B claims based on ICD-10 specificity.

If that thought makes you a little nervous, just remember these five things.

1. Know the Specifics You Need for Your Top Codes

You’ve spent the last year using ICD-10, so you’ve got a good idea of which codes you report most often and what those codes require. Put that experience to good use, revising job aids and documentation templates to take the frustration out of trying to find the many elements an ICD-10 code may require.

Example: Coding for atherosclerosis requires you to watch out for all of these elements, so make them easy to find in the documentation if you can.

  • Artery/Graft: Aorta, renal artery, native arteries, bypass graft (autologous vein, nonautologous biological, nonbiological, other), generalized, other
  • Extremity: Right leg, left leg, bilateral legs, other extremity
  • Related Issues: Intermittent claudication, rest pain, gangrene, ulceration (thigh, calf, ankle, heel and midfoot, other part of foot, other part of leg).

Keep in mind: The end of the flexibility period doesn’t mean you can never report an “unspecified” code to Medicare. As CMS says in question 27 of its ICD-10 guidance Q&A, unspecified codes may be acceptable and necessary when the documentation doesn’t support a more specific code.

2. Check 2017 Codes and Index Changes

Get your coding skills up to date so the switch to ICD-10 2017 doesn’t slow you down. Review the 2017 addenda available from the CDC. Skim through the Index changes, too. You don’t want to overlook easy to miss changes like stable angina switching from I20.9 (Angina pectoris, unspecified) to I20.8 (Other forms of angina pectoris).

And look into training available from specialty newsletters and webinars, too.

3. Go Over the Guidelines

Along with learning updates to the ICD-10 Index and Tabular, you need to review the recently posted Official Guidelines for ICD-10 2017. Scroll through, watching for changes signified by bold, underline, and italics. There are important changes covering a variety of areas from hypertensive heart disease to Zika.

4. Have a Plan to Track Denials

Perform an analysis of your current denials, and then keep track of denials that come in when you start using ICD-10 2017. Is there an overall uptick? What is triggering the denials? What can you do to prevent those denials in the future?

5. Keep Up the Good Work

The reality is, you’ve probably been reporting the correct and most specific ICD-10 codes to Medicare since you started using the new code set in 2015. That’s just good coding.

Plus, not all private payers allowed the same flexibility that CMS did, so you had to use the most specific codes for those claims. And even for Part B claims, you had to meet diagnosis coding requirements posted in LCDs and NCDs.

So the end of the grace period isn’t a change as much as it is a removal of a safety net you may have forgotten was there. Just keep following the same rules you always do — checking payer policies, working with providers on documentation, and using both the ICD-10 Index and Tabular to find the most appropriate code — and your claims will make it safely through payer review.

What About You?

Are you expecting to see denials increase after Oct. 1? Did you see denials from private payers increase during the past year due to ICD-10 issues?


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2 Top Ob-Gyn FAQs Revealed: Ob Confirmatory Visit and Lysis of Adhesions

Fri, Sep 9, 2016


ob-gyn coding FAQs

Every day brings new challenges for coders, but there are some questions that seem to come up over and over again. Our ob-gyn experts have revealed that two questions they hear very often relate to (1) the ob global and (2) lysis of adhesions during another procedure. Get a better understanding of how to triumph over these coding troublemakers with the details below.

1. Is the Confirmatory Visit in the Ob Global?

Generally speaking, you should not include the confirmatory visit in the ob global if the patient presents only to confirm the pregnancy and you don’t start the ob record. Starting the ob record involves things like starting an ob flow sheet, doing a complete prenatal history and exam, and ob coordination where the provider (not necessarily a physician) discusses the plans for ob-related lab tests, exams, and procedure guidelines.

Example: When a patient presents to the ob-gyn to confirm the results of a home pregnancy test, you may report this outside of the ob global using the code for the lab test. An E/M code may be appropriate if documentation supports it.

Watch out: If the patient presents because another physician has already confirmed the pregnancy, then that is a different situation. The patient is there specifically for ob care and to start the ob record.

Tip: Review the CPT® guidelines that accompany the maternity codes. You’ll get helpful advice such as the number of visits included and that “Pregnancy confirmation during a problem oriented or preventive visit is not considered a part of antepartum care and should be reported using the appropriate E/M service codes.”

2. Can You Report Lysis of Adhesions Separately?

For typical cases, you should not report lysis of adhesions separately when performed as part of another gynecological surgery. Removing adhesions to access the surgical site is an expected part of a gynecological procedure and payers factor that into their time and reimbursement estimates for the surgical code.

Not surprisingly, Correct Coding Initiative (CCI) edits bundle lysis codes such as 58660 (Laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]) and 58740 (Lysis of adhesions [salpingolysis, ovariolysis]) into long lists of surgical codes.

Example: CCI bundles 58660 into 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]). The modifier indicator is 0 so you can’t use a modifier to override the edit.

Option: In cases where documentation shows the gynecologist performed significantly more work than usual, involving more effort and time, then you may consider appending modifier 22 (Increased procedural services). Expect the use of 22 to trigger a manual review that requires you to back up the request for extra reimbursement that modifier 22 signifies.

If your payer provides guidelines on when using modifier 22 is appropriate, then keep them handy to be sure you meet the requirements. If you don’t have solid guidance to follow, then here are some tips from experts based on their experience:

  • Aim for at least 25 to 50 percent more time than usual, clearly documented
  • Explain the specifics of why the procedure took longer and required more work for that particular patient, such as obesity, unusual anatomy, or scarring outside the normal range.

What About You?

What coding questions do you have a tough time finding authoritative answers for? What advice have you been given?

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ICD-10 Diabetic Neurological Complications: May the Four Be With You

Tue, Sep 6, 2016


ICD-10 diabetic neurological complications

It wasn’t a long time ago or in a galaxy far, far away that we started using ICD-10. And in the near future, we’ll be dealing with another change for the code set.

Starting Oct. 1, 2016, choosing the fourth ICD-10 character and beyond has added importance for your Medicare claims, as explained below. I may not be Yoda or Obi-Wan, but I can tell you to use the fourth character 4 for diabetes with neurological complications. Here’s what you need to know if you don’t want your claims going over to the dark side. (And, I promise, the Star Wars references stop here.)

Refresh Your Knowledge of CMS Family Rule’s End

When ICD-10-CM 2017 goes into effect on Oct. 1, 2016, we’ll also be facing the end of Medicare’s grace period. The short version is that for the first 12 months of ICD-10 use, as long as the first three characters of the ICD-10 code are right, “Medicare fee-for-service will process and not audit valid ICD-10 codes.” That flexibility doesn’t change requirements put in place by LCDs and NCDs, but the end of that flexibility on Oct. 1 still adds some extra incentive to be sure we’re getting all characters for diabetes ICD-10 codes correct and as specific as possible.

Get the First Three Right

In ICD-10, the first three characters of a code are the category. The category that first comes to mind when you hear diabetes may be E11.- (Type 2 diabetes mellitus), but you have several categories to choose from:

  • E08.-, Diabetes mellitus due to underlying condition
  • E09.-, Drug or chemical induced diabetes mellitus
  • E10.-, Type 1 diabetes mellitus
  • E11.-, Type 2 diabetes mellitus
  • E13.-, Other specified diabetes mellitus.

Build Your Neurological Complications Code

Fourth: For all five of the categories above, adding the fourth character 4 indicates the patient has neurological complications of diabetes.

Fifth: Getting the right fourth character isn’t the end of the battle. You need to choose the applicable fifth character from this list:

  • 0, Diabetic neuropathy, unspecified
  • 1, Diabetic mononeuropathy
  • 2, Diabetic polyneuropathy
  • 3, Diabetic autonomic (poly)neuropathy
  • 4, Diabetic amyotrophy
  • 9, Other diabetic neurological complication.

Example: For a patient with type 2 diabetes with polyneuropathy, you should report E11.42 (Type 2 diabetes mellitus with diabetic polyneuropathy).

Simplify With Documentation You Can Count On

You can use the same building blocks we used above to create documentation templates so you have all of the information you need for coding neurological complications of diabetes. You also may want to include information from the Tabular showing that fifth character 2 applies to diabetic neuralgia and fifth character 3 applies to diabetic gastroparesis, so you and your providers can easily see which codes apply to those conditions.

What About You?

How do you make sure you get all the diabetes documentation you need?

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Ramp Up on Control and Creation Root Operation Changes for ICD-10-PCS 2017

Fri, Sep 2, 2016


root operation ICD10PCS 2017

Hi, hospital coders! The countdown to ICD-10-PCS 2017 is on, bringing a grand total of 75,789 codes. While you’re checking out the 3,827 new codes in the code set, be sure to take note of some revisions and additions to root operation definitions, which are associated with a code’s third character. Let’s take a look at Medical and Surgical changes to include in your PCS prep.

Dates: Use 2017 ICD-10-PCS code for discharges from Oct. 1, 2016, to Sept. 30, 2017.

Expand Control Beyond Postprocedural

In Section 0, Medical and Surgical, ICD-10-PCS 2017 updates the Definition and Includes/Examples listings for the operation known as Control.

2017 Definition (new words underlined): Stopping, or attempting to stop, postprocedural or other acute bleeding

The addition of those three little words, “or other acute,” significantly broadens the applicability of this operation, as you can see by the nature of the examples added for 2017.

2017 Includes/Examples (new words underlined, deleted words crossed through): Control of post-prostatectomy hemorrhage, control of post-tonsillectomy hemorrhage control of intracranial subdural hemorrhage, control of bleeding duodenal ulcer, control of retroperitoneal hemorrhage

Wider impact: The 2017 ICD-10-PCS Index will change the entry for “Control postprocedural bleeding in” to “Control bleeding in,” removing the term postprocedural. Tables will see a change in line with this update, too. For instance, the table for 0W3 (Anatomical Regions, General, Control) will show the new definition of Control that makes it clear it applies to other acute bleeding in addition to postprocedural bleeding.

Include Congenital Anomalies in Creation

You also need to watch for major changes in Section 0, Medical and Surgical, for the operation known as Creation. Pay particular attention to the Explanation section below to get the gist of the update. The changes are so sweeping that it helps to see the 2016 and 2017 entries side by side.


2016 Definition: Making a new genital structure that does not take over the function of a body part

2017 Definition: Putting in or on biological or synthetic material to form a new body part that to the extent possible replicates the anatomic structure or function of an absent body part


2016 Explanation: Used only for sex change operations

2017 Explanation: Used for gender reassignment surgery and corrective procedures in individuals with congenital anomalies


2016 Includes/Examples: Creation of vagina in a male, creation of penis in a female

2017 Includes/Examples: Creation of vagina in a male, creation of right and left atrioventricular valve from common atrioventricular valve


Examples: For Creation, ICD-10-PCS 2017 will offer codes starting with 024F0 for an aortic valve, 024G0 for a mitral valve, and 024J0 for a tricuspid valve.

Don’t Miss the Other Root Updates

We’ve taken a close look at changes to Control and Creation for Medical and Surgical, but there are other root operation changes, too.

Section 6, Extracorporeal Therapies, adds Perfusion, defined as “Extracorporeal treatment by diffusion of therapeutic fluid.”

And you’ll see new operations added for Section X, New Technology:

  • Assistance
  • Fusion
  • Insertion
  • Removal
  • Replacement
  • Reposition
  • Revision.

Resource: To review the definitions for these Section X changes, head to the CMS ICD-10 PCS and GEMs page. To see only changes, download the 2017 ICD-10-PCS Addendum.

How About You?

Have you gotten the hang of coding using ICD-10-PCS? Which changes would you like to learn more about?

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Ace or Uh Oh? Rate Your Contact Lens Coding Skills

Tue, Aug 30, 2016


contact lens ophthalmology practice coding

Are you the contact lens coding guru for your ophthalmology practice? Try your hand at this quick quiz to see how well you know your stuff.

Good Luck! Here Are the Questions

Question 1: Face the Fee Facts

The difference between the national nonfacility Medicare rates for 92071 (Fitting of contact lens for treatment of ocular surface disease) and 92072 (Fitting of contact lens for management of keratoconus, initial fitting) is roughly:

A. $1

B. $10

C. $100

Question 2: Optimize Coding for Ophthalmologist Services

When reporting contact lens prescription and fitting by an ophthalmologist, you should choose from:

A. 92310-92313

B. 92314-92317

C. 92012-92014

Question 3: Access Your ABN Knowledge

True or False: Providing an Advance Beneficiary Notice of Noncoverage (ABN) form to a Medicare beneficiary is voluntary for performing statutorily excluded refraction.

Question 4: Know What Prescription Packs In

Based on CPT® guidelines, prescription of contact lens may include:

A. Power, size, and curvature

B. Flexibility and gas-permeability

C. Both A and B

Check Your Answers

Answer 1

C. The national nonfacility Medicare rate for 92071 is $38.31. For 92072, the rate is $136.41. That’s a difference of nearly $100, so you want to be sure you never confuse these two contact lens fitting codes.

Code 92072 is specific to the initial contact lens fitting to manage keratoconus, which is a condition in which the cornea can’t maintain its natural round shape. Contact lens management for this condition (92072) requires more work than the contact lens fitting for ocular surface disease treatment that 92071 describes.

Answer 2

A. Codes 92310-92313 (Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation …) are the correct options when the ophthalmologist performs contact lens prescription and fitting.

If an independent technician performs the service, then choose from 92314-92317 (Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician …).

CPT® guidelines state that contact lens prescription is not part of the general ophthalmological service (such as 92012-92014).

Answer 3

True. ABNs are voluntary for statutorily excluded items. Consultants often advise providing an ABN anyway as good patient relations. Providing the ABN gives your practice a chance to discuss the service with the patient and let the patient know that Medicare does not cover the service and the patient will be financially responsible.

Answer 4

C. CPT® guidelines list all of the elements in both A and B as optical and physical characteristics that contact lens prescriptions may include.

How Did You Do?

4 right: You’re an eye coding ace!

2-3 right: Pretty good. Time to identify areas you should look at more closely.

0-1 right: Uh oh. Before you code your next eye claim, catch up on the latest advice from Ophthalmology Coding Alert. (Code for optometry? We’ve got you covered, too.)

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Keeping Up With the Colonoscopies: Screening Codes Special

Fri, Aug 26, 2016


colonoscopy screening CPT HCPCS

You know you’re a gastroenterology coder when you hear “screening colonoscopy” and your mind immediately presents all the different coding scenarios that simple phrase captures. Does your payer accept G codes or only CPT® screening colonoscopy codes? Was it for an average-risk patient or one at high risk? Did it turn into a diagnostic colonoscopy or therapeutic service? We could spend days getting into the nitty gritty of colonoscopy coding, but we’ll take a look at just two areas today.

1. Pinpoint Medicare’s High Risk Screening Colonoscopy Requirements

Whether the patient is high risk or not affects your code choice for Medicare and any other payers accepting these colonoscopy codes:

  • G0105, Colorectal cancer screening; colonoscopy on individual at high risk
  • G0121, … colonoscopy on individual not meeting criteria for high risk.

Remembering that you have G code options is tough enough, but then you also have to decide whether to use G0105 or G0121.

Answer: The Medicare Claims Processing Manual (MCPM), Chapter 18, Section 60.3 lists colorectal cancer screening guidelines centered on the characteristics of a high risk individual, such as a parent who has had colorectal cancer or a personal history of adenomatous polyps. Consider incorporating that list into your documentation training or templates to ensure you have the information you need to code properly.

That same MCPM section provides examples of ICD-10 codes that meet the high-risk criteria, so it’s worth keeping the link for that manual bookmarked on your browser.

Example: If documentation shows a screening for a Medicare beneficiary with a personal history of colonic polyps, you may select Z86.010 (Personal history of colonic polyps) to support choosing G0105.

Bonus tip: If the payer doesn’t accept G codes, then your most likely option is colonoscopy CPT® code 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]).

2. Make Room for Modifier PT When Screening Colonoscopy Converts

When the physician discovers an abnormality during a screening and performs a biopsy or procedure, then you’re no longer dealing with a screening. You should report the appropriate colonoscopy CPT® code that represents the service, such as a colonoscopy with biopsy CPT® code.

For Medicare and those payers following Medicare rules, you should append modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure) to the procedure code for colonoscopy to show the patient presented for a screening.

Experts suggest using modifier 33 (Preventive services) instead of PT for payers who don’t follow Medicare rules or accept PT.

What About You?

These issues are just the start for colonoscopy coding. What do you find to be the toughest colonoscopy scenarios to code? When did you finally feel like you were truly a coder?

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